scholarly journals The use of sugammadex in an infant with prolonged neuromuscular blockade - A case report -

2021 ◽  
Author(s):  
Hyunho Kim ◽  
Joonho Cho ◽  
Sangseok Lee ◽  
Yunhee Lim ◽  
Byunghoon Yoo
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Spontaneous Breathing ◽  
Upper Airway ◽  
Additional Dose ◽  
Residual Neuromuscular Blockade ◽  
Frequent Event ◽  
Prolonged Neuromuscular Blockade

Background: Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. Sugammadex is useful in reversing RNMB. However, its use in infants has not yet been approved by the Food and Drug Administration. Therefore, anesthesiologists can be hesitant use it, even in situations where no other choice is available.Case: A two-month-old baby presented to the hospital for umbilical polypectomy. At the end of the surgery, neostigmine was administered. Even after waiting for 30 min and injecting an additional dose of neostigmine, neuromuscular blockade was not adequately reversed. Eventually, sugammadex was administered, and spontaneous breathing returned.Conclusions: If there were no particular causes of delayed return to spontaneous breathing in infants, RNMB should be considered and reversal with sugammadex would be useful.

Case Report: Advanced Upper Airway Obstruction Caused by Cervical Goiter

1989 ◽  
Vol 297 (3) ◽  
pp. 176-177 ◽  
Author(s):  
Maria Chiriboga ◽  
John Oropello ◽  
Krishnan Padmanabhan ◽  
Joel M. Goldman
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction

scholarly journals Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

2002 ◽  
Vol 30 (6) ◽  
pp. 804-806 ◽  
Author(s):  
H. Butterell ◽  
R. H. Riley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Airway Obstruction ◽  
Pulmonary Oedema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Tracheal Compression ◽  
Negative Pressure Pulmonary Oedema ◽  
Life Threatening ◽  
Thyroid Goitre

We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.

scholarly journals Impaired Upper Airway Integrity by Residual Meeting Abstracts

2009 ◽  
Vol 110 (6) ◽  
pp. 1253-1260 ◽  
Author(s):  
Frank Herbstreit ◽  
Jürgen Peters ◽  
Matthias Eikermann
Keyword(s):  
Neuromuscular Blockade ◽  
Lung Volume ◽  
Upper Airway ◽  
Random Order ◽  
Compensatory Response ◽  
Residual Neuromuscular Blockade ◽  
Pharyngeal Pressure ◽  
Pressure Threshold ◽  
Airway Collapsibility ◽  
Closing Pressure

Background Residual neuromuscular blockade increases the risk to develop postoperative complications. The authors hypothesized that minimal neuromuscular blockade (train-of-four [TOF] ratio 0.5-1) increases upper airway collapsibility and impairs upper airway dilator muscle compensatory responses to negative pharyngeal pressure challenges. Methods Epiglottic and nasal mask pressures, genioglossus electromyogram, respiratory timing, and changes in lung volume were measured in awake healthy volunteers (n = 15) before, during (TOF = 0.5 and 0.8 [steady state]), and after recovery of TOF to unity from rocuronium-induced partial neuromuscular blockade. Passive upper airway closing pressure (negative pressure drops, random order, range +2 to -30 cm H2O) and pressure threshold for flow limitation were determined. Results Upper airway closing pressure increased (was less negative) significantly from baseline by 54 +/- 4.4% (means +/- SEM), 37 +/- 4.2%, and 16 +/- 4.1% at TOF ratios of 0.5, 0.8, and 1.0, respectively (P < 0.01 vs. baseline for any level). Phasic genioglossus activity almost quadrupled in response to negative (-20 cm H2O) pharyngeal pressure at baseline, and this increase was significantly impaired by 57 +/- 44% and 32 +/- 6% at TOF ratios of 0.5 and 0.8, respectively (P < 0.01 vs. baseline). End-expiratory lung volume, respiratory rate, and tidal volume did not change. Conclusion Minimal neuromuscular blockade markedly increases upper airway closing pressure, partly by impairing the genioglossus muscle compensatory response. Increased airway collapsibility despite unaffected values for resting ventilation may predispose patients to postoperative respiratory complications, particularly during airway challenges.

scholarly journals Angiofibrolipoma of the soft palate: A very rare cause of upper air way obstruction in an infant.

2020 ◽  
Vol 6 (1) ◽  
pp. 45-48
Author(s):  
Sonam Gyamtsho
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Soft Palate ◽  
Rare Case ◽  
Upper Airway ◽  
Female Child ◽  
Airway Compromise ◽  
Bipolar Cautery ◽  
History Of ◽  
Infant Case

Introduction: Infants and children are very prone to air way obstruction due to smaller and immature air ways. There are multiple causes of upper airway obstruction in infants like infections, congenital lesions and rarely tumours of the upper airway. However, angiofibrolipoma, a rare variant of lipoma causing intermittent respiratory distress in an infant has not been reported until now. Objective: To report a very rare case of angiofibrolipoma arising from the soft palate in an infant. Case report: Two and half months old female child reported to the department of otolaryngology with a history of intermittent airway obstruction since one month of age. After evaluation she was found to have a fleshy polypoidal mass above the laryngeal inlet arising from soft palate causing airway compromise. She underwent surgical excison with bipolar cautery under general anaesthesia. Conclusion: Few cases of angiofibrolipoma has been reported in adults but none has been reported in children. This is to report a case of angiofibrolipoma in child causing airway obstruction.

scholarly journals A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
David Olmstead ◽  
Gary Gelfand ◽  
Ian Anderson ◽  
John B. Kortbeek
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Subcutaneous Emphysema ◽  
Rare Complication ◽  
Traumatic Injury ◽  
Upper Airway ◽  
Acute Management ◽  
Airway Compromise ◽  
Current Management ◽  
Airway Patency

In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Current management of subcutaneous emphysema and its association with pneumothorax is summarized. Early decompression of underlying pneumothoraces in patients with significant subcutaneous emphysema should be performed to avoid this rare complication.

scholarly journals An Unusual cause of Acute Hypercapneic Respiratory Failure

2011 ◽  
Vol 5 ◽  
pp. CCRPM.S7687
Author(s):  
Janice Wang ◽  
Astha Chichra ◽  
Seth Koenig
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Diagnostic Imaging ◽  
Airway Obstruction ◽  
Pulmonary Disease ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Progressive Dyspnea

We present a rare cause of hypercapneic respiratory failure through this case report of a 72-year-old man presenting with progressive dyspnea and dysphagia over two years. Hypercapneic respiratory failure was acute on chronic in nature without an obvious etiology. Extensive workup for intrinsic pulmonary disease and neurologic causes were negative. Laryngoscopy and diagnostic imaging confirmed the diagnosis of diffuse idiopathic skeletal hyperostosis, also known as DISH, as the cause of upper airway obstruction leading to hypercapneic respiratory failure.

scholarly journals Residual Neuromuscular Blockade in Critical Care

2012 ◽  
Vol 32 (3) ◽  
pp. e1-e10 ◽  
Author(s):  
Jason Wilson ◽  
Angela S. Collins ◽  
Brea O. Rowan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Neuromuscular Blockade ◽  
Upper Airway ◽  
Surgical Interventions ◽  
Residual Neuromuscular Blockade ◽  
Factors Affecting ◽  
Anesthesia Time

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

scholarly journals Upper airway obstruction during extubation after general anesthesia, in a patient with Parkinson disease

Medicine ◽  
2020 ◽  
Vol 99 (21) ◽  
pp. e20363
Author(s):  
Xiaodi Sun ◽  
Leyang Dai ◽  
Yinbing Pan ◽  
Huanhuan Sha
Keyword(s):  
Parkinson Disease ◽  
Airway Obstruction ◽  
General Anesthesia ◽  
Upper Airway ◽  
Upper Airway Obstruction
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